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The anatomy of the scapula may predispose individuals to develop shoulder pathologies. The purpose of this study was to determine if the scapular anatomy, in particular the critical shoulder angle (CSA), changes over a long-term follow-up, or if it is a stable parameter. We hypothesized that increasing age would not influence the scapular morphology.We analyzed shoulder radiographs in our database from 2002 to 2019 to extract radiographs at an interval of at least 10 years. Radiographic analysis included measuring the CSA and assessing the acromion type according to Bigliani and Morrison, the posterior acromial height and the posterior acromial tilt.A total of 41 patients (47 shoulders) with a mean age of 53 years (range, 15-76; standard deviation [SD], ±14) fulfilled the inclusion criteria. The mean interval between the 2 sets of radiographs was 12 years (range, 10-16; SD ±2).The mean CSA did not change significantly with 34° (range, 20-41; SD ±4) at the first and 34° (range, 19-44; SD ±5) (P = .597) at the second assessment. On the initial lateral radiographs ("Neer view"), there were 11 type 1 (24%), 32 type 2 (70%), and 3 type 3 (6%) acromia according to Bigliani and Morrison. At the second assessment, there were 16 type 1 (34%), 28 type 2 (60%), and 3 type 3 (7%). Between both sets of radiographs, 11 were different (23%), without a trend in the type of change being discernible. The posterior acromial height was stable with 19 mm (range, 2-36; SD ±8) at the first and 18 mm (range, 5-38; SD ±8) at the second assessment (P = .186). The posterior acromion tilt changed from 59° (range, 34-81; SD ±10) to 62° (range, 30-81; SD ±10) (P.001). Among 6 cases with rotator cuff tears (RCTs) already at the first assessment, the CSA did not change significantly at 10 years' follow-up (P = .414). Among the 10 cases with new RCTs at the second assessment, the CSA did not change significantly at 10 years' follow-up from 34° (range, 25-41; SD ±5) to 35° (range, 24-44; SD ±6) (P = .510). In the group of 31 shoulders without RCT, the mean CSA at the first assessment of 34° (range, 28-41; SD ±3) stayed also stable with 34° (range, 28-40; SD ±3) (P = .796).The CSA is an anatomical parameter of the scapula that does not change in size after closure of the physes.

Purpose Pedicle screw loosening is a frequent complication in lumbar spine fixation, most commonly among patients with poor bone quality. Determining patients at high risk for insufficient implant stability would allow clinicians to adapt the treatment accordingly. The aim of this study was to develop a computational model for quantitative and reliable assessment of the risk of screw loosening. Methods A cohort of patient vertebrae with diagnosed screw loosening was juxtaposed to a control group with stable fusion. Imaging data from the two cohorts were used to generate patient-specific biomechanical models of lumbar instrumented vertebral bodies. Single-level finite element models loading the screw in axial or caudo-cranial direction were generated. Further, multi-level models incorporating individualized joint loading were created. Results The simulation results indicate that there is no association between screw pull-out strength and the manifestation of implant loosening (p = 0.8). For patient models incorporating multiple instrumented vertebrae, CT-values and stress in the bone were significantly different between loose screws and non-loose screws (p = 0.017 and p = 0.029, for CT-values and stress, respectively). However, very high distinction (p = 0.001) and predictability (R-Pseudo(2) = 0.358, AUC = 0.85) were achieved when considering the relationship between local bone strength and the predicted stress (loading factor). Screws surrounded by bone with a loading factor higher than 25% were likely to be loose, while the chances of screw loosening were close to 0 with a loading factor below 15%. Conclusion The use of a biomechanics-based score for risk assessment of implant fixation failure might represent a paradigm shift in addressing screw loosening after spondylodesis surgery., European Spine Journal, 31, ISSN:0940-6719, ISSN:1432-0932, ISSN:001991155

Introduction Little information is available on the clinical and radiographic outcome of intraoperative, non- to minimally displaced humeral fractures that occur during implantation of a stemmed, reverse shoulder prosthesis but are only recognized on routine postoperative radiographs. The goal of this study is to report the clinical and radiographic outcome for this rarely reported fracture type. Materials and methods 39 conservatively treated non- to minimally displaced intraoperative periprosthetic humeral fractures after stemmed RTSA were detected from our radiographic database between 1.1.2006 and 31.1.2018. Exclusion criteria were lack of patient consent, preoperative humeral fracture, and revision arthroplasties. Clinical (absolute and relative Constant score, the Subjective Shoulder Value) and radiographic (conventional radiographs) assessment was performed preoperatively, at 6 weeks (only radiographically) and at latest follow-up with a minimum follow-up of 2 years. Results 35 patient’s with a mean age of 72 years (range 32–88, SD ± 11 years) and a mean follow-up of 53 months (range 24–124, SD ± 31) were included in the study. At latest follow-up, all clinical outcome parameters except external rotation improved significantly. A complication rate of 17% (n:6) was recorded. At 6 weeks after the index surgery, none of the radiographs showed a fracture displacement or a sintering of the stem. At latest follow-up, all fractures were healed and no stem loosening was observed in any of the shoulders. Conclusions Non- to minimally displaced intraoperative periprosthetic humeral fractures in RTSA have an incidence of about 5% in this series of mainly uncemented press-fit stems. They generally heal without any further treatment and are not associated with stem loosening or compromise the clinical outcome after primary RTSA. Except slight restriction in the postoperative rehabilitation protocol, no further attention or action is needed.

Aims Our retrospective analysis reports the outcome of patients operated for slipped capital femoral epiphysis using the modified Dunn procedure. Results, complications, and the need for revision surgery are compared with the recent literature. Methods We retrospectively evaluated 17 patients (18 hips) who underwent the modified Dunn procedure for the treatment of slipped capital femoral epiphysis. Outcome measurement included standardized scores. Clinical assessment included ambulation, leg length discrepancy, and hip mobility. Radiographically, the quality of epiphyseal reduction was evaluated using the Southwick and Alpha-angles. Avascular necrosis, heterotopic ossifications, and osteoarthritis were documented at follow-up. Results At a mean follow-up of more than nine years, the mean modified Harris Hip score was 88.7 points, the Hip Disability and Osteoarthritis Outcome Score (HOOS) 87.4 , the Merle d’Aubigné Score 16.5 points, and the UCLA Activity Score 8.4. One patient developed a partial avascular necrosis of the femoral head, and one patient already had an avascular necrosis at the time of delayed diagnosis. Two hips developed osteoarthritic signs at 14 and 16 years after the index operation. Six patients needed a total of nine revision surgeries. One operation was needed for postoperative hip subluxation, one for secondary displacement and implant failure, two for late femoroacetabular impingement, one for femoroacetabular impingement of the opposite hip, and four for implant removal. Conclusion Our series shows good results and is comparable to previous published studies. The modified Dunn procedure allows the anatomic repositioning of the slipped epiphysis. Long-term results with subjective and objective hip function are superior, avascular necrosis and development of osteoarthritis inferior to other reported treatment modalities. Nevertheless, the procedure is technically demanding and revision surgery for secondary femoroacetabular impingement and implant removal are frequent. Cite this article: 2020;1-4:80–87.

Acetabular fractures are uncommon in children and adolescents, mainly because of predominant cartilaginous component and strong surrounding ligaments. Although acetabular fractures at this age can lead to significant disability, there is no consensus regarding management, which continues to be controversial. Particularly, long-term outcome after operative management has not been evaluated.We report a case of a 13-year-old boy skeletally immature who presented with an isolated acetabular fracture involving the posterior wall secondary to a traumatic hip dislocation. A Kocher-Langenbeck approach with a surgical luxation of the hip was used for reduction and mini-plate internal fixation of the fracture. Long-term (17-year) follow-up showed a good clinical outcome and a good congruence of the. The patient has bilateral beginning osteoarthritis due to a cam configuration of both hips CONCLUSION: We describe a case of successful operative management of an acetabulum fracture in a skelettaly immature child with a long-term follow-up. Aggressive management of this rare type of fractures may lead to durable positive outcome.

BACKGROUND AND IMPORTANCE Cavernous angiomas or cavernomas are vascular malformations usually located in the brain parenchyma. However, they rarely present as extra-axial lesions, attached to the dura, and may mimic meningiomas. Most reported cases concern the cavernous sinus region and other locations are very uncommon. CLINICAL PRESENTATION A 61-yr-old female known for long-standing mental illness presented with progressive gait instability. Imaging studies revealed an extra-axial lesion in relation to the anterior part of the falx cerebri. An interhemispheric approach was used to remove the lesion. Pathological analysis revealed features compatible with an extra-axial cavernoma: structureless vascular channels lacking smooth muscle and elastic lamellae, without intervening brain parenchyma. CONCLUSION Cavernous angiomas or cavernomas can present as extra-axial lesions. Although progressive growth can be observed, they should not be considered as tumoral lesions, because there is no cellular duplication. Unlike other locations, resection of anterior cranial fossa extra-axial cavernomas seems to be facilitated by minimal bleeding.

In this report, we describe an uncommon presentation of a Pott's puffy tumor, which is defined as a subperiosteal abscess related to a chronic frontal sinusitis. This condition has become rare in our part of the world because of the widespread use of antibiotics. Clinical history, investigations, and management are presented.